This is a form of HRT that combines estrogen and testosterone in one pill. The most commonly prescribed brand is Estratest, which contains esterified estrogens (Estratab) plus testosterone; however Premarin is also available in a testosterone-included form.

In general, the pros and cons are the same as you’d face taking testosterone and estrogen individually. A 1998 study concluded that adding small amounts of testosterone to HRT can restore a lagging libido and fight against hot flashes in addition to increasing bone density. Most research finds that testosterone is especially important for a woman who has undergone surgical menopause. When you have your ovaries removed, you aren’t producing the tiny amount of testosterone that a woman with ovaries does even after menopause. So there is a good chance that you may suffer from more intense hot flashes, more rapid bone loss, and a loss of interest in sex. By replacing the testosterone in addition to estrogen, you usually can reverse these symptoms.

The bad news? Some studies have shown that testosterone may raise blood pressure. The important factor is the ratio of testosterone to estrogen -- so if you do take Estratest or another testosterone in HRT, you should be sure to have your testosterone levels as well as your estrogen levels checked initially and tracked while you’re on the HRT. There are other possible side effects with testosterone as well -- including acne, facial hair, weight gain, increased anger, and, at the worst, liver disease. (The real key, though, appears to be the amount of testosterone taken.  These side effects don't appear to be a problem for women on low dosages.)

Finally, perhaps the biggest problem of all: Testosterone still hasn’t been studied closely, so it’s difficult to be sure what the long-term side effects may be. That said, though, it still may fit into your HRT picture -- especially if you’ve been through surgical menopause. In addition, the National Institutes of Health is currently studying testosterone replacement in women with POF, as their preliminary studies indicate that testosterone might be an important hormone for these women.   All in all, then, as with everything else related to HRT, it’s wise to discuss this carefully with your doctor.

The major decision in this case is whether you’d prefer taking the natural estrogen in Estratest or the conjugated estrogen in Premarin with methyltestosterone. In addition, the Premarin plus testosterone has a much higher dosage of testosterone in it -- over double the amount. Since many doctors advocate starting low with hormones, then building up if there’s no effect, you may be better off opting for the Estratest.   In addition, some doctors prescribe Estratest HS in conjunction with another estrogen -- you alternate between the two, so get only half a dosage of the testosterone.   In this way, you may be getting enough to help your problems, but not more than your body needs...and not enough to run the risk of side effects.